beating heart debakey vad implantation - the muenster technique
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Beating Heart DeBakey VAD Implantation -
the Muenster Technique
Dieter Hammel, Christof Schmidt*, Christof Schmid, Markus J. Wilhelm, Mario C. Deng & Hans H. Scheld
Depts. of Cardiothoracic Surgery & Anesthesiology*
Westfalian Wilhelms-University of Muenster
Muenster, Germany
“Beating Heart” - Implantation
• Sternotomy & device pocket• CPB (PFO exclusion or repair)• connection to apex• Device & driveline placement• Aortic anastomosis• De-Airing• Weaning & chest closure
Sternotomy & Device Pocket
• Sternotomy• Rectus sheath
preparation• M. transversus
dissection• Xiphoid resection
Diaphragm Dissection
• Pericardial incision• Enbloc-incision of
diaphragm & pericardium(2 x GIA 75mm)
• Re-adaptation of diaphragm & M. transversus(Vicryl-sutures)
Cannulation, PFO Exploration
• Aortic cannulation
• Digital exploration of the atrial septum via the venous pursestring suture
• PFO closure if mandatory
• CPB initiation
Apex Anastomosis I
• LV apex elevation
• 8 Ethibond (3-0 MH) sutures with 2 teflon felt strips (circular)
• 4 of 8 knots of apical fixation ring
• Apical incision
• Excision of the LV apex -> coring device
• Removal of additional tissue / thrombus from the LV apex
Apex Anastomosis II
• Inflow cannula insertion
• Suturing of inflow cannula suture ring to the apical fixation ring (Ethibond)
• Final running suture (3-0 Prolene) between felt strips and inflow cannula suture ring
Apex Anastomosis III
• Tension free device positioning (pocket size !)
• Graft protector wrapping with a 22 mm PTFE prosthesis
• De-airing via a large vent
Device Placement & Outflow Wrapping
• Skin incision in the lower right quadrant
• Preparation of a subcutaneous tunnel using a sponge forceps for trocar protection
Driveline Tunneling
Aortic Anastomosis
• Measuring of the outflow graft length
• End-to-side anastomosis (4-0 Prolene, delayed tying for adequate deairing)
• CVP by CBP & pump start (start NO inhalation)
Weaning from CBP & Outflow graft wrapping II
• Weaning• Wrapping of
distal outflow graft with remainder of PTFE prosthesis
• Drainage and chest closure as usual
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